甲襞微循环检测在原发性干燥综合征伴间质性肺病患者中的临床意义

Clinical Significance of Nailfold Capillaroscopy in Patients with Primary Sjgren's Syndrome Complicated with Interstitial Lung Disease

目的分析原发性干燥综合征(pSS)伴间质性肺病(ILD)患者甲襞微循环的变化,探讨甲襞微循环检测对pSS-ILD诊断和病情评估的作用。方法回顾性分析2011年8月至2017年2月徐州医科大学附属医院首诊的141例pSS患者的临床资料,根据有无ILD分为pSS-ILD组(n=80)和无ILD组(n=61),所有病例均进行了甲襞微循环、肺部高分辨率CT(HRCT)和动脉血氧分压检查,观察两组甲襞微循环的差异,分别分析pSS-ILD组甲襞微循环总分与HRCT评分和动脉血氧分压的关系。结果无ILD组甲襞微循环总分、HRCT评分显著低于pSS-ILD组[(5.21±2.65)分比(6.97±3.27)分,(6.01±4.33)分比(8.36±3.57)分,P<0.01];动脉血氧分压显著高于pSS-ILD组[(86.14±19.37)mm Hg(1 mm Hg=0.133 k Pa)比(76.46±17.67)mm Hg,P<0.01];pSS-ILD组甲襞微循环总评分与HRCT评分呈正相关(r=0.80,P<0.001),与动脉血氧分压呈负相关(r=-0.88,P<0.001)。结论pSS-ILD组较无ILD组的患者甲襞微循环发生异常更严重,比例更高,甲襞微循环检测可能有助于pSS-ILD的诊断;甲襞微循环总评分与HRCT评分呈正相关,与动脉血氧分压呈负相关,可能作为pSS-ILD病情评估的一项指标。

Objective To analyze the changes of nailfold capillaroscopy in patients with primary Sjgren＇ s syndrome（ pSS） complicated with interstitial lung disease（ ILD）,to investigate the effect of nailfold capillaroscopy on the diagnosis and evaluation of pSS-ILD. Methods From Aug. 2011 to Feb. 2017,141 pSS patients admitted to the Affiliated Hospital of Xuzhou Medical University were analyzed retrospectively. The patients were divided into a pSS-ILD group（ n = 80） and a non-ILD group（ n = 61） according to the presence or absence of ILD. All cases were performed with nailfold capillaroscopy,high-resolution CT（ HRCT） and arterial blood gas oxygen partial pressure（ PaO_2）. Differences between the two groups were analyzed. Correlations between nailfold capillaroscopy total scores with the HRCT scores and PaO_2 were compared respectively. Results Nailfold capillaroscopy total scores and HRCT scores of the non-ILD group were significantly lower than those in the pSS-ILD group[（ 5. 21 ± 2. 65） score vs（ 6. 97 ± 3. 27） score,（ 6. 01 ± 4. 33） score vs（ 8. 36 ± 3. 57） score,P〈0. 01 ],PaO_2 score was significantly higher than that in the pSS-ILD group [（ 86. 14 ± 19. 37） mm Hg（ 1 mm Hg =0. 133 k Pa） vs（ 76. 46 ± 17. 67） mm Hg,P〈0. 01]; in pSS-ILD group,there was a positive correlation between nailfold capillaroscopy total scores and HRCT score（ r = 0. 80,P〈0. 001）,while there was a negative correlation between nailfold capillaroscopy total scores and PaO_2 score（ r =-0. 88,P〈0. 001）. Conclusion A higher proportion of abnormal nailfold capillaroscopy in patients with pSS is more likely to contribute to the diagnosis of pSS-ILD. The nailfold capillaroscopy total scores is positively correlated with HRCT score and negatively correlated with PaO_2 score,which may be used as an indicator of pSS-ILD condition.